title: Image-guided robotic stereotactic body radiation therapy for liver metastases: is there a dose response relationship?
abstract: OBJECTIVE
  To evaluate the outcome, tolerance, and toxicity of stereotactic body radiotherapy, using image-guided robotic radiation delivery, for the treatment of patients with unresectable liver metastases.
  
  
  METHODS
  Patients were treated with real-time respiratory tracking between July 2007 and April 2009. Their records were retrospectively reviewed. Metastases from colorectal carcinoma and other primaries were not necessarily confined to liver. Toxicity was evaluated using National Cancer Institute Common Criteria for Adverse Events version 3.0.
  
  
  RESULTS
  Forty-two patients with 62 metastases were treated with two dose levels of 40 Gy in four Dose per Fraction (23) and 45 Gy in three Dose per Fraction (13). Median follow-up was 14.3 months (range, 3-23 months). Actuarial local control for 1 and 2 years was 90% and 86%, respectively. At last follow-up, 41 (66%) complete responses and eight (13%) partial responses were observed. Five lesions were stable. Nine lesions (13%) were locally progressed. Overall survival was 94% at 1 year and 48% at 2 years. The most common toxicity was Grade 1 or 2 nausea. One patient experienced Grade 3 epidermitis. The dose level did not significantly contribute to the outcome, toxicity, or survival.
  
  
  CONCLUSIONS
  Image-guided robotic stereotactic body radiation therapy is feasible, safe, and effective, with encouraging local control. It provides a strong alternative for patients who cannot undergo surgery.
authors.affiliation: Département universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Vautravers-Dewas
authors.forename: Sylvain
authors.initials: S
authors.lastname: Dewas
authors.forename: François
authors.initials: F
authors.lastname: Bonodeau
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.forename: Thomas
authors.initials: T
authors.lastname: Lacornerie
authors.forename: Nicolas
authors.initials: N
authors.lastname: Penel
authors.forename: Eric
authors.initials: E
authors.lastname: Lartigau
authors.forename: Xavier
authors.initials: X
authors.lastname: Mirabel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011859:Radiography; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012074:Remission Induction / Q000379:methods; D012119:Respiration; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult